Medi-Cal Rx
**The Department of Health Care Services (DHCS) has announced that full Medi-Cal Rx Implementation will begin January 1, 2022.
Effective January 1, 2022, CenCal Health Pharmacy Benefits will transition to Medi-Cal Rx. Medi-Cal Rx is the transition of all administrative services related to Medi-Cal pharmacy benefits billed on pharmacy claims from the existing intermediaries to the new Medi-Cal Rx vendor, Magellan Medicaid Administration, Inc. (MMA). To learn more about this transition, please watch the Medi-Cal Rx & Magellan Health Transition Prescriber Training video or reference the presentation slides.
DHCS will take the necessary steps to ensure beneficiaries are able to receive their prescriptions and that pharmacies will have available needed information regarding claims and prior authorizations, and to ensure that Medi-Cal managed care plans will receive the necessary data to ensure appropriate utilization and continuity of care for beneficiaries enrolled in managed care.
You may also want to visit the Medi-Cal Rx Communication page for any upcoming bulletins and news.
Gain Access to the Medi-Cal Rx Secured Portal
Pharmacy Training Checklist
Prescriber Training Checklist
Medi-Cal Rx Portal Frequently Asked Questions
Join the Secured Medi-Cal Rx Provider Portal!
RSV Season 21-22
Respiratory Syncytial Virus (RSV) Season and Palivizumab Accessibility
CenCal Health is preparing for RSV Season and prophylactic palivizumab (Synagis®) administration in collaboration with CenCal Health's Specialty Pharmacy Optum® Specialty and CenCal Health's Pharmacy Benefit Manager, MedImpact.
Synagis® prophylaxis season will begin, November 1, 2021 and run through March 31, 2022. CenCal Health's Pharmacy Benefit Manager, MedImpact will begin accepting Synagis Prior Authorization/Enrollment Forms on October 15, 2021 for initial Synagis® administration on or after November 1, 2021. Synagis® is available from CenCal Health's Specialty Pharmacy vendor, Optum Specialty Pharmacy.
Below are the appropriate forms for Synagis® Prior Authorization and Order Fulfillment:
Synagis Specialty Fulfillment FAQ
Synagis Enrollment Form
Synagis Re-Order Form
Atypical/Off-Season RSV Season Requests:
Consistent with the CDPH advisory and the American Academy of Pediatrics recent interim guidance, potential off-season requests will be considered thru CenCal Health's palivizumab (Synagis®) prior authorization process.
The California Department of Public Health has issued a Health Advisory regarding the Off-Season use of palivizumab:
CDPH-Health Advisory: Off-Season Respiratory-Syncytial Virus Infections and Use of Palivizumab
For any questions, please reach out directly to the CenCal Health Pharmacy Department at (800) 421-2560 ext. 1080.
Flu Season 21-22
Prepare for Flu Season 2021-2022
The Flu Season is now upon us. The Pharmacy Flu Program can help your patients stay healthy this flu season. As part of the pharmacy benefits provided by CenCal Health and MedImpact, our members are eligible to receive the flu vaccine directly from a participating pharmacy in our network. CenCal Health members may choose from a variety of participating pharmacy locations including drug stores, supermarkets, retailers and independent pharmacies. Members may contact their local pharmacy for vaccination hours and appointment requirements. If providers choose to administer the flu vaccine in their office, they can bill CenCal Heath’s medical benefit.
If you have questions regarding the Pharmacy Flu Program, please contact the CenCal Health Pharmacy Services Department at (800) 421-2560 ext. 1080.
Blood Pressure Monitors-Formulary Updates
Automatic/Digital Home Blood Pressure Monitors
Effective May 1, 2021, Home Blood Pressure Monitors are a CenCal Health covered Pharmacy Benefit with a valid prescription sent to a contracted retail pharmacy. The valid prescription shall be sent to the member's retail pharmacy for fulfillment.
CenCal Health's Home Blood Pressure Monitor benefit includes:
One home blood pressure monitor every 5-years with a valid prescription from a provider.
For a complete list of Home Blood Pressure Monitors/NDCs available on the CenCal Health Formulary, please click here.
Physician Administered Drug Updates
Preferred Biosimilars Effective 7/1/2021
Preferred Biosimilars
Preferred Biosimilars Effective 1/1/2021
Preferred Biosimilars
New Treatment Authorization Request (TAR) Requirements Effective 10/1/2020
Medical Pharmacy Benefit Physician Administered Drug Update
Formulary Updates
April-May 2021